Kuzmin Boris, Staack Thorsten, Wippermann Jens, Wacker Max
Department of Cardiothoracic Surgery, Otto-von-Guericke University, Magdeburg, Germany.
J Card Surg. 2021 Feb;36(2):723-725. doi: 10.1111/jocs.15222. Epub 2020 Dec 16.
Closure of the left atrial appendage is a common procedure for patients with atrial fibrillation undergoing cardiac surgery. The technique of left atrial appendage occlusion (LAAO) by an extracardiac clip (AtriClip) is established as a reliable method. Acute coronary obstruction of the circumflex artery has already been described after minimally invasive LAAO. Here, we report a case of delayed circumflex artery obstruction after open-heart surgery. A patient who had mitral and tricuspid valve surgery in combination with AtriClip implantation suffered from myocardial infarction 24 h after clip implantation. Cardiac catheterization showed that the circumflex artery was obstructed on the level of the AtriClip device. The stenosis was treated by percutaneous coronary intervention with stent implantation. In conclusion, the surgeon should consider placing the AtriClip device slightly far away from the base of the left atrial appendage to avoid coronary obstruction.
对于接受心脏手术的房颤患者，左心耳闭合术是一种常见的手术。心外夹子（AtriClip）封堵左心耳（LAAO）技术已被确立为一种可靠的方法。微创LAAO术后已出现回旋支急性冠状动脉阻塞的报道。在此，我们报告1例心脏直视手术后延迟性回旋支动脉阻塞的病例。1例接受二尖瓣和三尖瓣手术并植入AtriClip的患者在夹子植入后24小时发生心肌梗死。心脏导管检查显示，AtriClip装置水平处的回旋支动脉阻塞。通过经皮冠状动脉介入治疗并植入支架对狭窄进行了处理。总之，外科医生应考虑将AtriClip装置放置在距左心耳基部稍远处，以避免冠状动脉阻塞。
